Illustration: June Hsu

At the end of a dusty road in the southern African hinterland sits a small concrete building with an orange door. It is a structure so modest and remote that it is hard to believe it could hold lessons for addressing one of the world’s biggest challenges.

The unit is the medical hub for Gasita, a village of 2,000 people in the south of Botswana. Inside one of the rooms, pharmaceutical supplies are neatly stashed on shelves while a photograph of Botswanan President Mokgweetsi Masisi is propped up on a counter next to a window that is ajar, letting in a warm breeze.

Outposts like these — offering family planning services, contraception and education — have helped bring about one of the world’s most remarkable demographic shifts. In a continent where fertility rates are the highest in the world and populations are soaring, Botswana has a different story to tell.

Fifty years ago, Botswanan women would have seven children on average. Now they have fewer than three. It is one of the fastest-falling fertility rates anywhere in the world — a dramatic decline that merits scrutiny.

The world’s population is on track to hit 8 billion in 2023 and almost 10 billion by 2050. Sub-Saharan Africa is set to grow faster than anywhere: There were 1 billion Africans in 2010, but that number will grow to 2.5 billion by 2050.

Some have warned that this growth risks “driving civilization over the edge,” a controversial view given that it is rich countries, not poor, that lead the way on consuming the world’s resources.

However, enabling women to control their fertility — a move that almost inevitably leads to them having fewer babies — is not just about a tussle over resources, or the environment: it brings enormous ramifications for women’s health, education and employment — with knock-on effects for society and the economy.

So what did Botswana get right?

In a ground-floor office at the University of Botswana, in the country’s capital of Gaborone, Chelsea Morroni considers the issue.

“Everyone is always asking: How did this happen?” Morroni says.

An expert in international sexual and reproductive health at the Liverpool School of Tropical Medicine, Morroni has lived in Botswana with her family for five years. As founder and director of the Botswana Sexual and Reproductive Health Initiative, she spends her days delving into issues around fertility and contraception.

“There’s been a huge amount of change in Botswana,” she says, pointing out that since Botswana became an independent country in 1966, the landscape developed quickly, with high levels of economic growth and development of both healthcare and education infrastructure, enabling young women to become educated and have employment opportunities.

“All of those things on the macro level are really important to fertility declines anywhere in the world,” says Morroni, whose work is part of the Botswana UPenn Partnership, a collaboration between the Botswana Ministry of Health, the University of Botswana and the University of Pennsylvania.

However, the country made more direct strides, too.

“Botswana also was very proactive in the early years in establishing a family planning program, so in setting up a program that was far-reaching in terms of its geographical reach, providing access to most people in the country to a range of contraceptive methods,” Morroni says.